The effect of copper on Alzheimer’s disease has been the focus of a number of studies. Research had been conducted on the effects of various metals on Alzheimer’s for many years, but studies of how copper might affect the disease are more recent.

Early studies on the relation between Alzheimer’s and copper involved mice. Some of these studies suggested a link while others showed no connection. In 2003, two studies found that higher copper levels in mice produced positive results. The mice had fewer plaques – a build-up of deposits in the brain associated with progression of Alzheimer’s. A 2002 study by Harvard Medical School suggests that metals such as copper and zinc may turn plaques into rogue enzymes, producing hydrogen peroxide to damage brain cells.

A ground-breaking study was conducted in 2003. The Sun Health Institute, Arizona, and West Virginia University were conducting research into the effects of a high cholesterol diet on Alzheimer’s and how fat accelerated the growth of plaques in the brains of rabbits. But the researchers noticed that rabbits who drank pure water did better than those who drank water with traces of copper. A separate study was carried out where one group of the cholesterol-fed rabbits was given tap water which contained copper and the other group drank distilled water. The amount of copper was less than the level considered safe for human consumption.

After ten weeks, rabbits who received tap water had a greater build-up of plaques in their brains than those rabbits that drank distilled water. The group drinking tap water also fared worse in memory tests compared with the other group. Researchers blew a puff of air into the rabbits’ eyes following a noise. Rabbits normally learn to close their eyes on hearing the noise but the study group didn’t remember to do this. What the researchers found was that the copper inhibited the breakdown of plaques from the brains of these rabbits. The distribution of the plaques in the rabbits’ brains was found to be similar to that of people with Alzheimer’s. Previous research into links between Alzheimer’s and copper had been less clear.

The Saarland University Medical Center in Germany conducted a clinical trial to assess the effects of copper orotate (an organic salt) on seventy people with Alzheimer’s in 2005. Half the patients were given eight milligrams of copper orotate a day and the rest a placebo (or fake). Each patient didn’t know if they were on copper orotate or in the control group. The study found that patients with low plasma copper levels in their blood made more mistakes in a memory test than patients with higher levels. Further the copper orotate was found to be well tolerated by patients.

Other researchers have found that an imbalance of metals such as copper, iron and zinc may cause a build-up of brain plaques linked to Alzheimer’s. If older people have a high cholesterol diet, copper may cause deterioration in memory, thinking and learning, and lead to accelerated onset of Alzheimer’s. The Institute for Healthy Aging at Rush University Medical Center measured trans and saturated fats and copper consumption levels of about 3,700 older Chicago residents over a period of six years to 2006. Copper was only found to be associated with cognitive decline in people who consumed high levels of fat. Within this group, the more copper they consumed, the greater the rate of cognitive decline.

In 2007, the University of Rochester Medical Center found that mice who drank water with 0.12 milligrams of copper per liter had twice the copper in their brains than mice that drank distilled water. The mice drinking the copper water also had a third fewer low density LRPs (lipoprotein receptor-related proteins) and a third more plaques in their brains. In human cells, copper was found to cause sufficient damage to these proteins and they no longer worked to reduce the build-up of the beta amyloids. Everyone has plaques, and they increase with age. Alzheimer’s accelerates the build-up. Eventually these plaques kill brain cells, a previous finding of the study team.

A study at Keele University, UK in 2013 found that copper is unlikely to cause the formation of plaques in the brain. The research found that copper was potentially protective against beta amyloid build-up.

Thus some research links low copper levels with Alzheimer’s and other research links high levels with it. No studies have found that copper causes the disease, and more research would need to be done before such a conclusion could be made. There is also a need to know more about how copper breaks down LRPs.

It should be pointed out that copper is a natural component of various foods. Liver and shellfish have the highest levels of copper. Other foods high in copper include red meat, legumes, grains, potatoes, nuts, seeds, many vegetables and fruits, and chocolate. Indeed, a certain level of copper is necessary for good health. People need it for sturdy bones, energy, healthy blood, and a strong immune system. Also, water via copper pipes can contain trace amounts of copper.

As people age, their brains become more prone to inflammation and oxidation. People with Alzheimer’s develop what are called amyloid plaques, which consist of dense layers of protein molecules and cell material that build up in the brain. Plaques cause further oxidation and inflammation. Food containing antioxidants and other useful compounds may help slow the build-up and fight the unstable molecules or free radicals that damage the brain.

The main antioxidants are vitamin C or ascorbic acid, vitamin E, beta-carotene, selenium and polyphenol. Ascorbic acid can’t be stored in the body so it’s important that patients eat foods rich in this vitamin. The main sources are brightly colored fruit and vegetables, for example, broccoli, green leafy vegetables, potatoes, green peppers, cabbage, strawberries, blueberries and cranberries. Antioxidants give these vegetables and fruits their color. Plants produce antioxidants naturally to protect themselves against disease and pollution, and the benefits are passed on to us when we eat them.

A symposium on the health benefits of berries in 2007 heard that blueberries and cranberries may slow the cognitive decline in people with Alzheimer’s. A study found that aging mice manipulated to develop Alzheimer’s improved their cognition with high consumption of blueberries. In a study of about seventy older dogs, the University of California’s Institute for Brain Aging and Dementia found that dogs fed an antioxidant-rich diet had reduced amyloid plaque build-up.

Vitamin E has been found to slow down the progression of Alzheimer’s according to a 1997 study in the New England Journal of Medicine. Vitamin E is a fat-soluble vitamin and can be stored in the liver. Main sources include nuts and seeds, green leafy vegetables, whole grains, wheat germ, fish-liver oil and vegetable oil.

Another useful antioxidant that is thought to reduce the rate of cognitive decline in people with Alzheimer’s is beta-carotene. It protects orange, green and yellow fruit and vegetables from damage by solar radiation and is found in foods such as tomatoes, apricots, peaches, cantaloupe, sweet potatoes, spinach, broccoli, pumpkin and mangoes.

Selenium is a mineral that may help reduce cell damage and slow down the loss of brain function. It can be obtained through foods such as fish, shellfish, chicken, eggs, red meat, cereals and also vegetables if grown in soil with selenium.

Polyphenol antioxidants may also assist in reducing the progress of Alzheimer’s. Foods rich in polyphenol include broccoli, cabbage, celery, parsley and onion, as well as apples, cantaloupe, cherries, grapes, pears, plums, blackberries, blueberries, cranberries, raspberries and strawberries. It is also found in grains, most legumes, green tea, bee pollen, olive oil, chocolate and red wine.

It is not only foods with antioxidants that may help with Alzheimer’s. Vitamin B-12 is one of a group of eight water-soluble vitamins within the Vitamin B complex and has most relevance to Alzheimer’s, with deficits being linked to cognitive decline. The best sources are liver, shellfish, milk, cereals, trout, salmon and beef. Adequate intake of vitamin B-12 may slow down the progression of the disease.

Omega-3 can assist too as it helps control calcium levels. Excessive calcium in brain cells contribute to a build-up of amyloid plaques, which Alzheimer’s patients have in high quantities. Omega-3 fatty acids can be found in fish such as salmon, tuna, mackerel, herring, anchovies and sardines. It is also found in fruit such as kiwifruit, as well as eggs. Swedish studies have found a reduction in cognitive decline among people with mild Alzheimer’s who took omega-3 supplements.

Alyson Hendershot of Nutritionally Yours in the US runs seminars for Alzheimer’s patients on the best foods to eat. She recommends sticking with basic fresh foods and to eat a good variety of them. Her advice on what to avoid includes salt, preservatives, artificial colorings and flavorings, caffeine, white bread and cakes, sugary snacks and too much processed food in general.

Patrick Holford, who runs workshops on nutrition in the UK, believes that people with Alzheimer’s would benefit from eating wholefoods such as fresh vegetables and fruit, wholegrains, nuts and seeds, and to avoid highly processed or overcooked food. He says to avoid sugar in any form.

A range of food herbs that could improve or maintain cognition levels in those with Alzheimer’s include cinnamon, cloves, galangal, ginger, lemon balm and nutmeg. The antioxidants in these plants help reduce the damage by oxidants to the brain.

While many foods contain compounds that may show the progression of Alzheimer’s, it is important to note that no food or supplement, or any pharmaceutical or other treatment for that matter, offers a cure for the disease. So far they can only reduce a patient’s rate of decline or perhaps in some instances prevent it in the first case.

Alzheimer’s disease has no cure. However, a range of alternative pharmaceutical treatments can assist towards giving a patient relief from the symptoms. There are also other, non-pharmaceutical treatments that can help improve the patient’s quality of life.

The five drugs approved for Alzheimer’s by the US Food and Drug Administration are Aricept, Cognex, Exelon, Razadyne and Namenda. Alternative treatments do not come under the scrutiny of the FDA. Their effectiveness, safety and purity are not known and consumer problems aren’t recorded. Before taking any alternative treatment, check with your doctor to see if your prescription medication or any other drug clashes with it. Limited testing has been done on alternative treatments, mainly small studies with inconclusive results.

Clioquinol, an antibiotic and metal chelator, may reduce Alzheimer’s progression. It inhibits beta-amyloid, a build up of cellular debris or plaques in the brain of people with Alzheimer’s. Studies are limited but encouraging. Patients have been found to have lower beta-amyloid levels, higher zinc levels, and slower cognitive decline albeit only in more severely affected people. In general, antibiotics have been found to improve mental function. Side effects include nausea, diarrhea and poor sleep. The Alzheimer’s Association does not recommend using antibiotics to treat the disease.

Coenzyme Q10 is a naturally occurring antioxidant providing the body with energy and is therefore promoted as a supplement for Alzheimer’s. The Mayo Clinic reports that preliminary research has found that it may slow down the disease. Idebenone is a synthetic variant of coenzyme Q10, and studies have claimed it to be an effective treatment. However, the Alzheimer’s Association says tests using a synthetic version of this drug were not favorable.

Coral calcium is from dead organisms that used to be part of a coral reef. It has been widely promoted as a cure for Alzheimer’s and other diseases such as cancer. The FDA has complained about it, saying there’s no scientific evidence to back the claims.

Ergoloid mesylates have been used to treat dementia for many years in Europe. They act as an anti-oxidant and dilator of blood vessels in the brain. Benefits so far are very limited. Side effects include nausea, vomiting, tongue irritation and appetite loss. Studies are small, and allergies to these drugs are common. They may not be suitable during pregnancy or breast feeding, or with liver disease, mental illness, low blood pressure or slow heart beat.

Estrogen is being looked at as a possible preventative medication in the very early stages of Alzheimer’s in females. It affects areas of the brain relevant to memory. Studies have found a decreased risk of Alzheimer’s and better cognition. Animal studies have found that estrogen assists memory. However, an increased likelihood of heart attack, stroke, breast and ovarian cancer, and high blood pressure has put future research in doubt.

Galantamine is an acetylcholinesterase inhibitor that claims significant improvement in cognition and other symptoms in large trials of several hundred people. Functions and activities of patients improved, and they needed reduced caregiver support. Behavior also improved and Alzheimer’s progression was slowed. However, there were neurological side effects.

Ginko biloba is a plant extract that may have beneficial properties for the body and brain. The Chinese have used it for centuries. It is supposed to increase brain function and improve cognitive function. It has antioxidant and anti-inflammatory properties, reduces plaques, and increases the flow of blood to the brain. Some studies have shown slight improvement in patients’ brain function, daily activities such as dressing, and better social behavior. Other studies have shown no effect. Side effects include clotting, and thus potentially internal bleeding, and it can react adversely with anesthesia. Risk may increase if taken with other blood-thinning drugs like aspirin and warfarin. The level of active ingredients can vary between ginko products.

Huperzine A is a moss extract from Chinese herb Huperzia serrata. It is used as a dietary supplement. Again, the Chinese have used it for a long time. It works in a similar way to the FDA approved Aricept by increasing the neurotransmitter acetylcholine. Research has claimed it to be effective, with improvement shown in cognition, memory and behavior, but studies so far have been small. The FDA does not recommend it as there have been no significant studies into its effectiveness, safety or side effects. Manufacture is unregulated and has no uniform standards.

Melissa officinalis or lemon balm has been used for many years as a mild sedative that has a calming effect and reduces stress. It is used to improve memory too. It is thought to bind to acetylcholine. Small studies in England and Iran have found that it improves memory. No significant side effects have been found.

Omega-3 fatty acids may reduce cognitive decline according to research. Clinical trials of omega-3 have been small and inconclusive, but results from epidemiological and laboratory studies have been promising. They are known to reduce heart disease and stroke risk, benefit blood vessels, and may even help depression. A recent study found they might help nerve cells by assisting with the growth of branches linking cells to one another, creating a nerve cell forest that allows the brain to process and store information.

Phosphatidylserine is a fat in the membranes around nerve cells. These cells deteriorate with Alzheimer’s. The use of this drug may help the membrane to prevent or slow cells from degenerating. Animal tests were conducted in the UK with encouraging results, but the outbreak of mad cow disease ended the research. Since then, a clinical trial has been conducted of older people with memory impairment. Results were promising but larger trials would be needed before this drug can be used to treat Alzheimer’s.

Statin drugs have been found to reduce the risk of Alzheimer’s. It is thought that statins help alpha-secretase to break down the amyloid proteins that promote a build-up of plaques in the brain. Statins are usually used to reduce cholesterol and treat vascular disease but more research is needed before using it for Alzheimer’s. Studies have been limited and participants weren’t selected randomly. Side effects are significant and include heart failure, cancer, neuropathy, pancreatic rot, muscle pain, dizziness and depression.

THC, marijuana’s active ingredient, may become a successful alternative treatment for the disease. A test tube study found that THC prevented plaque build-up more successfully than mainstream drugs. The study claimed that Aricept and Cognex blocked the formation of plague only 22 percent and seven percent as well as THC respectively.

Vitamin E supplements might slow down the progression of Alzheimer’s, although the rate is thought to be minimal. Studies suggest a mild improvement in function but not in cognition. However, side effects can include nausea, diarrhea and fatigue. It may have adverse interaction with other medication.

Non-pharmaceutical treatments are worth considering too, such as fruit and vegetable juices, herbal and green tea, sunlight, music and aroma therapy, and acupuncture, all of which may slow the Alzheimer’s process. Lastly, it should be said that a good diet and healthy lifestyle will also help.

At the severe stage of Alzheimer’s disease, short-term and long-term memory is very poor or non-existent. Communication is simple and might comprise single words or phrases without linking things, or people may lose their speech altogether.

Ninety percent of patients at this stage of Alzheimer’s experience apathy. Aggression is less common, as a person has by this time lost the will and is too tired. Extreme exhaustion sets in and they sleep a lot. They need help with daily activities. Washing, dressing and eating independently are not possible. They are increasingly incontinent and need help with the toilet.

They are unsure of current surroundings or recent events, and might forget significant amounts of personal history and names of family members. Their personality changes. Delusions, hallucinations and paranoia are common. They may wander from home and get lost.

Eventually, a person can’t control their movements. They can’t walk, sit or smile, and they don’t know family members, including their spouse, although sometimes this could be partly due to visual impairment. They have seizures and weight loss and may refuse to drink or eat.

Finally, mobility is impaired and the person can’t get out of bed. Their whole body is overcome with the disease. They are susceptible to pneumonia, pressure sores and ulcers, and can die from these conditions before their body falls apart from the effects of Alzheimer’s.

At the third stage of Alzheimer’s, or the moderate stage, short-term memory becomes worse and long-term memory may also be impaired. A person might not be able to remember things they did recently. They might have problems with mental arithmetic that used to cause them no problems.

A person may forget aspects of their own background such as medical history, and might make something up to fill the gaps. They may forget their address, which school they went to, and don’t always know where they are or what day it is. Communication can be difficult. The person can’t always find the right word and doesn’t read or write much. They may repeat themselves, not finish sentences and may revert to their first language.

A person’s independence may be restricted. They may require assistance outside and at home with a range of activities. Driving, shopping, banking and paying bills might be difficult. They may still be able to eat, wash and dress, albeit with difficulty, but might not dress for the occasion or season, or might put their night clothes over the top of their day clothes.

Their appearance may change. Hygiene may become lax. Incontinence becomes common. They may take others’ things, and might not recognize themselves in the mirror. They can be restless, tap objects repetitively, wring their hands, find it hard to get comfortable on a chair, wander about chatting, and may become night-owls. They might need almost constant supervision as they may burn, injure or poison themselves.

Changes in behavior occur, such as increased irritability and aggressiveness. A person may laugh or cry for little apparent reason. Delusions occur in thirty percent of patients. It becomes hard to always know what a person wants.

Sadly, a person might not be aware of their shortcomings and inabilities, and might deny their problems. They might accuse others of making them look silly. Care is often resisted, causing difficulties for family members and for carers.

Delusions, poor communication and aggression make things harder. They can become withdrawn. Hiding objects is common. They may think their spouse is having an affair or family members are stealing from them.

Alzheimer’s is often harder on families than on the patient, as sufferers aren’t always aware of how bad things have become, and families may eventually be forced to consider long-term care solutions.

The second stage or mild stage of Alzheimer’s disease is where learning and memory impairments get a little worse and more noticeable to family, friends and colleagues. Symptoms include short-term memory loss, difficulty learning new things and poor concentration.

A doctor will be able to measure memory loss through testing and will often diagnose a person with Alzheimer’s at this stage. But a person can still clearly remember old times, things they’ve already learnt, and how to do day to day activities.

Some people at the mild stage suffer language problems such as a more limited vocabulary, or their speech is less fluent. Others can show signs of clumsiness in their daily activities, such as dressing, washing and eating, although they can still do most of these basic tasks quite satisfactorily.

Other common symptoms at this stage of Alzheimer’s include forgetting names and words, reduced comprehension ability, difficulty making decisions and becoming less organized. Work performance may not be quite as good.

Things are often misplaced, for example, a person might put their keys in the oven or wallet in the washing machine. Judgment can be poor, so driving a motor vehicle might be a problem.

Apathy appears in at least forty per cent of sufferers at this stage. A person might forget to eat or eats too much, or they might hoard things.

Some “benefits” include falling asleep easily and being more immune to colds.

The first stage of Alzheimer’s disease is often called pre-dementia or mild cognitive impairment. This stage involves very mild signs of deficiency that don’t affect daily life to any extent.

The most common symptom at this time is short-term memory loss, for example, a person may forget familiar words or names of people they know, or where they’ve put their glasses or keys. Thought processes might not always be totally logical. Apathy, where a person can be indifferent about various aspects of life, can occur at this stage, although it is more common later.

These symptoms are around the boundary of the normal ageing process and Alzheimer’s, and are seen as possible warning signs for the disease. Very mild symptoms can occur for a number of years before a person is diagnosed with Alzheimer’s. However, they don’t always mean a person is heading for the disease.

Diagnosis is less usual at this stage as symptoms can relate to so many other things or indeed the normal ageing process. Many people have a poorer short-term memory than long-term memory throughout their lives. Also, apathy can relate to stress or depression rather than Alzheimer’s.

Often only in hindsight do we know whether a person exhibiting very mild symptoms had Alzheimer’s all along.

Alzheimer’s is a degenerative illness that starts with memory loss and progresses to complete loss of awareness and bodily functions, and death. The disease features a build-up of amyloids or plaques in the brain. An estimated 36 million people have Alzheimer’s worldwide (2010).

The disease can be divided into several stages. A staging system is a useful way of gaining a broad understanding of the usual symptoms at each stage and as a way of grouping the symptoms. However, the stages are only a guide. Each person is different and may show signs of more than one stage at a time.

Alzheimer’s is a natural progression. The stages overlap, and a person doesn’t suddenly jump from one stage to the next. Progression through the stages varies too, from about four years to twenty years, although a person typically lives seven to ten years after diagnosis. All stages involve a progressive cognitive and functional decline.

Three stages are often used in Alzheimer’s: early, mid and late; or mild, moderate and severe. An initial very mild or pre-dementia stage is sometime added to this system, and a moderately severe stage between the moderate and severe stages. The other commonly used staging system in Alzheimer’s has seven stages, as used by the Alzheimer’s Association: no impairment, very mild decline, mild decline, moderate decline, moderately severe decline, severe decline and very severe decline. The “no impairment” stage, where a person shows no signs of memory loss, isn’t included in the three or four stage system.

I have used a four stage system: very mild, mild, moderate and severe. My next four articles will cover these stages.

We don’t know what actually causes Alzheimer’s, but there are many factors that result in a person having a greater or lesser risk of developing the disease. Risk factors for Alzheimer’s include age, family history, genetics, gender, general health and various lifestyle factors.

Age is the most important risk factor for Alzheimer’s. Older people are far more likely to develop the disease than young people. One in 100 people aged 60-64 years who don’t have a close family relative with Alzheimer’s can expect to develop the disease. This increases to a 1 in 25 chance for people aged 70-74 years, 1 in 5 for those aged 80-84 years, and 1 in 2 or 3 for people aged 90-94 years. It is estimated that a quarter of people over 85 years of age have Alzheimer’s.

Family history is the second main risk factor in developing Alzheimer’s. If a person has a parent or sibling with Alzheimer’s, the risk is 2-3 times higher. A third of those with Alzheimer’s have a parent, brother or sister with the disease. The risk increases if two generations have Alzheimer’s, such as a parent and sibling, or parent and grandparent on the same side of the family, and if they both had Alzheimer’s before the age of 65 years.

Genetics are another factor. Two genes connected with familial Alzheimer’s have been identified so far: a “risk gene” called Apolipoprotein E and a “deterministic gene”. There may be up to a dozen more risk genes associated with the disease. Everyone has two Apolipoprotein E genes. There are three types of these genes, known as types 2, 3 and 4. A person can have two of the same type, for example, 3, 3, or two different types, for example, 2, 4. Those with a type 4 are at greater risk of Alzheimer’s at a younger age, especially people with two type 4s. Type 2 carries the least risk. Researchers are trying to work out why all this is the case.

The deterministic gene is associated with early onset Alzheimer’s, a much rarer form of the disease. A person has a 1 in 2 chance of getting this from age 30-60 years if a parent has it. Early onset is entirely familial, unlike the more common late onset Alzheimer’s, which can be familial or non-familial.

People with Down syndrome are at higher risk of developing Alzheimer’s. This can occur from around the age of 40 years. Most of them will eventually develop the disease if they live long enough. These people are at greater risk due to their additional chromosome. This gives them an extra copy of the gene for the protein that causes amyloid build-up, a feature of Alzheimer’s.

Gender is a risk factor in developing Alzheimer’s. Women have a slightly higher risk, even allowing for the greater proportion of women among the older population. Women taking hormone replacement therapy are less likely to get Alzheimer’s, according to some studies, although one study found an increased risk in women with low oestrogen levels.

Severe head injuries are thought to increase the risk of Alzheimer’s in later life. A study found that people who are unconscious for fifteen or more minutes from a head injury are more prone to develop the disease than those with no head injury. Other studies have been inconclusive. Curiously, head size can make a difference to whether a person might get the disease. People with small heads are at more risk.

Heart disease, stroke, diabetes, high blood pressure and high cholesterol may increase the likelihood of getting Alzheimer’s. The connection between brain and heart is an important one. With every heart beat, nearly a quarter of the blood pumped from the heart goes to the head. Thus people with a poor vascular, or blood vessel, system are at greater risk of developing the disease. This can come about through smoking, diabetes, hypertension or diet.

Diabetes may be linked directly to Alzheimer’s. A symptom of both is amyloid deposits appearing in the pancreas and the brain respectively. Research into a possible relationship is ongoing.

High blood pressure is often associated with Alzheimer’s, as it can damage the brain’s blood vessels and reduce oxygen. This could upset nerve cell circuits, which may be important to cognitive skills.

Research suggests high cholesterol levels mean a higher risk of Alzheimer’s. Logically, this means that people who take cholesterol reducing drugs will be less likely to get the disease. Some studies into the use of statins, the most common drug taken to lower cholesterol, have found a reduced risk while others have been inconclusive. Other research has shown that the animo acid homocysteine may increase the risk of the disease.

Food high in trans and saturated fats raises the chances of Alzheimer’s. High fat consumption can increase the risk of diabetes and hypertension, which in turn may increase the risk of developing the disease. A study of about 3,700 older people in Chicago found that those who ate a high fat diet were more likely to suffer cognitive decline associated with Alzheimer’s. Good nutrition, on the other hand, is thought to reduce the likelihood of the disease.

Studies suggest anti-inflammatory drugs such as ibuprofen, indomethacin and naproxen may lower the risk of Alzheimer’s, although clinical tests have not shown a link so far. Any reduced risk may be offset by side effects including stomach irritation and gastrointestinal bleeding.

A link between aluminum accumulations in the brain and Alzheimer’s was first reported in 1965. Studies have found that people exposed to aluminum in antiperspirants, antacids and drinking water have a greater risk of developing the disease.

A postmortem study in New York found that depression is a risk factor in Alzheimer’s. The study compared the brains of people who had Alzheimer’s and a known history of depression with those who weren’t diagnosed with depression. People with depression had more brain plaques and tangles, which are associated with Alzheimer’s.

Education level is sometimes considered a risk factor for Alzheimer’s. Studies have found that people with a higher level of education are less likely to get the disease. This may be due to the fact that more education means greater use of the brain, and those who have undertaken more courses of study are more likely to use their brain in other areas of their lives, including as they get older. Research has shown that a person with an active brain is less at risk of Alzheimer’s.

Scientists believe that a combination of risk factors rather than any single factor is what may ultimately increase or decrease a person’s likelihood of developing Alzheimer’s. Thus if a person is high on the risk scale for a number of factors, such as family history, heart disease and high fat diet, then all of these factors rather than just one of them may contribute to the person eventually having Alzheimer’s.

Alzheimer’s is a progressive brain disease where a person suffers various memory, learning, communication and thinking problems. Visible symptoms or early warning signs can be subtle and vague, and can be hard to differentiate from what might be construed as normal. Symptoms may come on gradually and be unnoticed for a long time. Family and friends may mistake warning signs for part of the normal aging process and vice versa.

The first warning sign that someone might have undiagnosed Alzheimer’s is usually memory problems, especially remembering things that have happened recently. A person in the pre-diagnosis stage might ask the same question a number of times over a relatively short period or they might tell the same story several times. They may forget familiar words, and might make up words in their place, for example, a pencil might be called a stick or a thing. Names of people they know may be increasingly forgotten. They might not know where they’ve put their glasses or keys. Other memory warning signs include reduced concentration and comprehension, forgetting to keep several appointments, and forgetting things that were recently learned.

Poor memory, especially short-term memory, is common in many people. If someone occasionally forgets a name or an appointment or phone number and then recalls these things later, this is normal behavior and not a sign of Alzheimer’s. A test of whether a person might have the disease is where they forget something and they don’t later remember they’ve forgotten.

Another common warning sign is difficulty performing tasks. A person with undiagnosed Alzheimer’s might start forgetting how to do all the steps involved in cooking a meal, repairing something, paying bills, doing their banking, shopping, or phoning someone. They might have difficulty with day to day activities such as dressing, washing, and eating, for example, they may forget to eat or eat too much or eat a whole meal of the one food. Decisions can become difficult to make, including simple things such as what to have for tea or what to wear. They are less organized, and work colleagues might see a decline in work performance. Warning signs don’t include occasionally forgetting why you’ve gone into a room or putting two spoons of sugar in your coffee and you usually have one.

Poor judgment is another common warning sign. A person might forget to bathe, saying they have bathed already. They may wear the same clothes for several days, saying they’re clean. Sometimes a person may dress in clothes inappropriate to the season or they might put their night clothes on over the top of their day clothes. Erratic driving might become a problem. They might hoards things, or take or steal things owned by others. Giving away a lot of money or spending it inappropriately may occur. Making the odd poor decision or forgetting the umbrella on a rainy day doesn’t mean a person may have Alzheimer’s.

Family members may see mood and behavioral changes in the person they think might have Alzheimer’s. There can be sharp mood swings and the person can be unpleasant for no reason. They may laugh at something not particularly funny, and then cry at something not especially sad or worrying. An occasional bad mood due to some occurrence at work or home doesn’t count. Changes in personality can occur. A person might become suspicion, develop fears, and show confusion. They might think their spouse is having an affair, or a family member has stolen something. They increasingly prefer to rely on their spouse to do tasks previously done by themselves. Strangely, a person in the early stages of Alzheimer’s gets fewer colds.

A person with undiagnosed Alzheimer’s might develop problems with communication and language. They may communicate less with family, friends, and work colleagues. They might have more limited vocabulary, shorter sentences, and stop in the middle of a sentence more often. Speech may be less fluent. They may not be able to find someone listed in a phone book. They may also revert to a first language more often.

Being unable to think of the right word in conversation or writing wouldn’t be a sign. Abstract thinking and complex mental reasoning are sometimes a problem for people who may have Alzheimer’s. For example, a person usually good with numbers might be slower at mental arithmetic or have difficulty counting backwards in threes. But if a person is naturally not numbers oriented and they have difficulty reconciling their bank account balance, this could be quite normal.

Being disoriented with place and time and losing things are further warning signs. People might forget familiar surroundings, becoming lost in places they normally know. They might forget how to get home or the route to a place they frequently visit. They may also have a tendency to wander and get lost. Misplacing things more frequently or putting them in strange places could point to Alzheimer’s, for example, putting the wallet in the fridge or keys in the washing machine. However, simply forgetting where you’ve put your keys and later finding them still in the car or in your bag instead of in the drawer, or temporarily forgetting the day of the week, isn’t a sign of Alzheimer’s.

Signs of a loss of initiative or apathy could occur in a person who may have Alzheimer’s. They may become indifferent about various aspects of life, become more passive, and want to go out less. Instead, they may watch more television or sleep more. They might need reminding to do things and have less enthusiasm for activities they have always enjoyed. But this warning sign needs to be treated with caution just as all the others do. Apathy can relate to other conditions, such as stress or depression. Also, everyone can feel lazy sometimes, and might be tired because of a busy schedule and skip an activity now and then.

Researchers in Sweden examined 47 studies that included investigation into the warning signs of Alzheimer’s between 1985 and 2003, finding that people later diagnosed with the disease had deficiencies in their thinking processes and their short-term memory. The researchers found smaller deficiencies in communication ability, spatial skills, and attentiveness among people in the pre-diagnosed stage of Alzheimer’s. The findings were consistent across the studies and showed that the warning signs could be many and complex.

However, they found that the major deficiencies were similar to the normal aging process and that there was no clear difference between a normal 75-year-old and someone before being diagnosed with Alzheimer’s. Early diagnosis can be difficult for this reason. They also found that early onset was followed by a period of relative stability, and then decline, before diagnosis. Another interesting finding was that the warning signs are more visible in younger people, as they tend to have a greater build-up of brain plaques.

There are many warning signs that a person may have Alzheimer’s, although the presence of symptoms doesn’t necessarily mean a person has the disease. Signs can be visible years before the disease is diagnosed. A difficulty is that a person often doesn’t realize they might have a problem or might be reluctant to accept that warning signs are there. If you know someone you think might be displaying the signs of Alzheimer’s, encourage them to see a doctor.